Angela D Wallace

NPI #1114204450 in Shawnee, Oklahoma

Provider Information

NPI Number: 1114204450
Entity Type: Individual
Name: Angela D Wallace
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor - Mental Health
Enumeration Date: Nov 15, 2011
Last Updated: Nov 15, 2011

Practice Location

Address: 101 N UNION AVE
City: Shawnee
State: Oklahoma
ZIP Code: 74801-7067
Phone: (405) 878-1135

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Mental Health — Mental Health	101YM0800X	Primary

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